Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures
Yıl: 2020 Cilt: 26 Sayı: 5 Sayfa Aralığı: 811 - 817 Metin Dili: İngilizce DOI: 10.14744/tjtes.2020.39888 İndeks Tarihi: 04-11-2020
Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures
Öz: BACKGROUND: We aimed to compare clinical and functional outcomes between patients treated with Dynamic hip screw (DHS)and Proximal Femoral Nail-Antirotation (PFN-A) implants.METHODS: This study included 122 patients (66 men [54.1%] and 56 women [45.9%]) who underwent surgery with DHS andPFN-A for an intertrochanteric femur fracture and had at least 12 months follow-up. Reduction assessment, femoral neck-shaft angleand tip-apex distance measurements were performed in early postoperative radiographs. On control visits in months 1, 3, 6 and 12,range of motion, thigh or hip pain, and Trendelenburg positivity were assessed in clinical examination and reduction assessment, femoralneck-shaft angle and tip-apex distance measurements were performed on radiographs after the union. Patients were assessed usingHip Harris Score after the union.RESULTS: Regardless of implant type used, mean tip-apex distance measured at the immediate postoperative period was 27.6 inpatients with implant failure, whereas 21.6 in patients without, indicating a significant difference. Again, mean femoral neck-shaft anglemeasured at the immediate postoperative period was 123 degree in patients with implant failure, whereas 130 degree in those without,indicating a significant difference. It was found that the femoral neck-shaft angle was <128 degree in all patients with implant failurewhereas it was >128 degree in 94% of patients without implant failure at immediate postoperative period.CONCLUSION: The findings regarding femur neck-shaft angle at the immediate postoperative period was <128 degree in allpatients with implant failure and that it was ≥128 degree in 94% of patients without implant failure emphasize the importance ofanatomic restoration in femur neck-shaft angle during surgery. The finding that mean tip-apex distance was 27.6 mm in patients withimplant failure and 21.6 mm in patients without implant failure indicates that the technique is as important as implant type selectedfor treatment success of the implantation.
Anahtar Kelime: A1 ve A2 tipi femur intertrokanterik kırıklarında kayan kalça vidası ve proksimal femur çivisi-antirotasyon ile tespit sonrası hastaların fonksiyonel sonuçlarının karşılaştırılması
Öz: AMAÇ: Dinamik hip screw (DHS) ve proksimal femoral çivi-antirotasyonu (PFN-A) implantları ile tedavi edilen hastaların klinik ve fonksiyonel sonuçlarını karşılaştırmayı amaçladık. GEREÇ VE YÖNTEM: Çalışmaya Kırıkkale Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı’nda femur intertrokanterik kırığı nedeniyle DHS ve PFN-A kullanılarak ameliyat edilen, en az 12 ay takibi olan 66’sı erkek, 56’sı kadın olan toplam 122 hasta alındı. Hastaların erken postoperatif grafilerinde kırığın redüksiyonu değerlendirilmesi, boyun cisim açısı ve tip apeks mesafesi ölçümleri yapıldı. Postoperatif 1. ay, 3. ay, 6. ay, 12. ay yapılan takiplerinde kalça eklem hareket açıklığı, uyluk-kalça ağrısı, Trendelenburg pozitifliği bakıldı ve takiplerdeki ve kaynama sonrası çekilen grafilerinde redüksiyon, fiksasyon kaybı, boyun cisim açısı ve tip apeks mesafesi ölçümleri yapıldı. Hastalar kaynama sonrası dönemde Kalça Harris Skoru ile değerlendirildi. BULGULAR: Kullanılan implanttan bağımsız olarak implant yetmezliği görülen grupta erken postoperatif ölçülen tip apeks mesafesi ortalaması 27.6 iken implant yetmezliği görülmeyen grupta 21,6 idi ve istatistiksel olarak anlamlı bir fark saptandı. Kullanılan implanttan bağımsız olarak implant yetersizliği görülen grupta erken postoperatif ölçülen boyun cisim açısı ortalaması 123 iken implant yetersizliği görülmeyen grupta 130 idi ve istatistiksel olarak anlamlı bir fark saptandı. İmplant yetersizliği görülen hastaların tümünde erken postoperatif ölçülen boyun cisim açısının 128 derecenin altında olduğu saptandı. İmplant yetersizliği görülmeyen hastaların %94’ünün erken postoperatif ölçülen boyun cisim açısının 128 derecenin üstünde olduğu saptandı. TARTIŞMA: İmplant yetersizliği olan hastaların tümünde erken postoperatif boyun cisim açısının 128° altında olması ve implant yetersizliği görülmeyen hastaların %94’ünde erken postoperatif boyun cisim açısının 128° ve üzerinde olması cerrahi sırasında bu açının anatomik şekilde restore edilmesinin önemini ortaya çıkarmaktadır. İmplant yetersizliği görülen grupta TAD’nin ortalama 27.5 mm ve implant yetersizliği görülmeyen grupta ortalama 21.7 olması, bu sistemlerin implantasyonunda tedavi başarısı açısından tekniğin en az seçilen implant türü kadar önemli olduğunu göstermektedir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthop Relat Res 2004;425:72–81.
- 2. Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br 2005;87:112–36.
- 3. Dodds SD, Baumgaertner MR. The sliding hip screw. Curr Opin Orthop 2004;15:12−7.
- 4. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res 1998;348:87−94.
- 5. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 1995;77:1058−64.
- 6. Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am 1998;80:618−30.
- 7. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 1984;186:45−56.
- 8. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2008;3:CD000093.
- 9. Anglen JO, Weinstein JN; American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 2008;90:700−7.
- 10. Bellabarba C, Herscovici D Jr, Ricci WM. Percutaneous treatment of peritrochanteric fractures using the Gamma nail. Clin Orthop Relat Res 2000;375:30−42.
- 11. Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 2002;16:386−93.
- 12. Papasimos S, Koutsojannis CM, Panagopoulos A, Megas P, Lambiris E. A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Arch Orthop Trauma Surg 2005;125:462−8.
- 13. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am 1979;61:216−21.
- 14. Zuckerman JD. Hip fracture. N Engl J Med 1996;334:1519−25.
- 15. Browner B, Levine A, Jüpiter J, Trafton P, Krettek C. Skeletal Trauma. 2 Vol. WB Saunders Company, 1996.
- 16. Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop 2006;30:69−78.
- 17. Larsson S. Treatment of osteoporotic fractures. Scand J Surg 2002;91:140−6.
- 18. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 1990;72:26−31.
- 19. Şahin S, Ertürer E, Oztürk I, Toker S, Seçkin F, Akman S. Stabil olmayan intertrokanterik femur kırıklarının tedavisinde proksimal femoral çivi antirotasyon osteosentezinin radyografik ve fonksiyonel sonuçları Acta Orthop Traumatol Turc 2010;44:127−34.
- 20. Ertürer E, Sönmez M, Sarı S, Seçkin F, Kara A, Öztürk İ. Yaşlı hastalarda intertrokanterik kalça kırıklarında Profin® çivisi ile intramedüller osteosentez. Acta Orthop Traumatol Turc 2012;46:107−12.
- 21. Boyd HB, Anderson LD. Management of Unstable Trochanteric Fractures. Surg Gynecol Obstet 1961;112:633−8.
- 22. Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 1997;79:969−71.
- 23. Ahrengart L, Törnkvist H, Fornander P, Thorngren KG, Pasanen L, Wahlström P, et al. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res 2002;401:209−22.
- 24. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 2010;92:792−8.
- 25. Habernek H, Wallner T, Aschauer E, Schmid L. Comparison of ender nails, dynamic hip screws, and Gamma nails in the treatment of peritrochanteric femoral fractures. Orthopedics 2000;23:121−7.
- 26. Jaworski JM, Gaździk TS, Kaleta M, Dec J, Godula R. Treatment of trochanteric fractures of the femur: DHS or Gamma nail? - own experience. Ortop Traumatol Rehabil 2003;5:53−9.
- 27. Utrilla AL, Reig JS, Muñoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 2005;19:229−33.
- 28. Xu YZ, Geng DC, Mao HQ, Zhu XS, Yang HL. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res 2010;38:1266−75.
- 29. Kristek D, Lovrić I, Kristek J, Biljan M, Kristek G, Sakić K. The proximal femoral nail antirotation (PFNA) in the treatment of proximal femoral fractures. Coll Antropol 2010;34:937−40.
- 30. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br 2005;87:76−81.
| APA | Sevinç H, Cirpar M, Canbeyli I, Dağlar B, Oktas B, DURUSOY S (2020). Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. , 811 - 817. 10.14744/tjtes.2020.39888 |
| Chicago | Sevinç Hüseyin Fatih,Cirpar Meric,Canbeyli Ibrahim Deniz,Dağlar Bülent,Oktas Birhan,DURUSOY SERHAT Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. (2020): 811 - 817. 10.14744/tjtes.2020.39888 |
| MLA | Sevinç Hüseyin Fatih,Cirpar Meric,Canbeyli Ibrahim Deniz,Dağlar Bülent,Oktas Birhan,DURUSOY SERHAT Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. , 2020, ss.811 - 817. 10.14744/tjtes.2020.39888 |
| AMA | Sevinç H,Cirpar M,Canbeyli I,Dağlar B,Oktas B,DURUSOY S Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. . 2020; 811 - 817. 10.14744/tjtes.2020.39888 |
| Vancouver | Sevinç H,Cirpar M,Canbeyli I,Dağlar B,Oktas B,DURUSOY S Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. . 2020; 811 - 817. 10.14744/tjtes.2020.39888 |
| IEEE | Sevinç H,Cirpar M,Canbeyli I,Dağlar B,Oktas B,DURUSOY S "Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures." , ss.811 - 817, 2020. 10.14744/tjtes.2020.39888 |
| ISNAD | Sevinç, Hüseyin Fatih vd. "Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures". (2020), 811-817. https://doi.org/10.14744/tjtes.2020.39888 |
| APA | Sevinç H, Cirpar M, Canbeyli I, Dağlar B, Oktas B, DURUSOY S (2020). Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. Ulusal Travma ve Acil Cerrahi Dergisi, 26(5), 811 - 817. 10.14744/tjtes.2020.39888 |
| Chicago | Sevinç Hüseyin Fatih,Cirpar Meric,Canbeyli Ibrahim Deniz,Dağlar Bülent,Oktas Birhan,DURUSOY SERHAT Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.5 (2020): 811 - 817. 10.14744/tjtes.2020.39888 |
| MLA | Sevinç Hüseyin Fatih,Cirpar Meric,Canbeyli Ibrahim Deniz,Dağlar Bülent,Oktas Birhan,DURUSOY SERHAT Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.5, 2020, ss.811 - 817. 10.14744/tjtes.2020.39888 |
| AMA | Sevinç H,Cirpar M,Canbeyli I,Dağlar B,Oktas B,DURUSOY S Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(5): 811 - 817. 10.14744/tjtes.2020.39888 |
| Vancouver | Sevinç H,Cirpar M,Canbeyli I,Dağlar B,Oktas B,DURUSOY S Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(5): 811 - 817. 10.14744/tjtes.2020.39888 |
| IEEE | Sevinç H,Cirpar M,Canbeyli I,Dağlar B,Oktas B,DURUSOY S "Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.811 - 817, 2020. 10.14744/tjtes.2020.39888 |
| ISNAD | Sevinç, Hüseyin Fatih vd. "Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures". Ulusal Travma ve Acil Cerrahi Dergisi 26/5 (2020), 811-817. https://doi.org/10.14744/tjtes.2020.39888 |
